AA SS SS EE SS SS MM EE NN TT RR EE PP OO RR TT

Clearing of site for returning refugees from Chad, Moyenne Sido, 18 Feb. 2008

Moyenne Sido Sous-Prefecture, Ouham

17 – 19 February 2008

Contents

1. Introduction & Context……………………………………………………………….

2. Participants & Itinerary ……………………………………………………………...

3. Key Findings …………………………………………………. …………………….

4. Assessment Methodology……………………………………………………….....

5. Sectoral Findings:

NFI’s, Health & Nutrition, WASH, Protection, Education ……………………….

6. Recommendations & Proposed Response…………. ……………......

2

Introduction & Context

The sous prefecture of Moyenne Sido came into creation in March 2007, making it the newest sous- prefecture in the country. As a result, it has a little civil structure and has not received any major investment from the governmental level, and currently there is only the Mayor who is struggling to meet the needs of both the returnees and the host population, the latter is estimated at 17,000 persons. During the course of the visit, he was followed by several groups of elderly men (heads of families) who were requesting food from him, or any other form of assistance. The Mayor was distressed that neither the governmental authorities nor humanitarian agencies have yet been able to provide him with advice or assistance.

The returnees are mainly Central African Republic citizens who fled to southern Chad after the coup in 2003. Since then, they have been residing at Yarounga refugee camp in Chad. Nine months ago, they received seeds from an NGO called Africa Concern, which they were supposed to plant and therefore be able to provide food for themselves. However, the returnees have consistently stated that the land they were set aside for farming was dry and arid, and they were unable to grow their crops there. They have stated they did not receive WFP food rations for approximately nine months, and so hunger has driven them back across the border into CAR.

Since arriving in CAR over the past two months, most have stayed in Moyenne Sido with the local population. However, the situation has now become strained; the host community are struggling to provide even for themselves. The mayor has taken the decision to “seize” some farming land, and clear it for the use of the returnees(housing). When the mission visit, the clearing of the site was ongoing and it was being divided up into 20m x 15m sites for each family, and the families were working to dig out the allotments. No farming land has been allocated. The organisation of this exercise is being carried out by the local Croix Rouge.

Returnees in Moyenne Sido

Security context:

3

Although no Coupeur de Route or banditry activities were reported in the location of Moyenne Sido, there were some incidents noted in the preceding weeks on the areas of Batangafo and Kabo as detailed below:

19 January 2008: Bogono, (Batangafo – Ouandago axe) – village looted

24 January 2008 : Kabo – Batangafo axe at Moissala, CDR attack

05 February 2008: Bogono, (Batangafo – Ouandago axe) – village looted

Note that MSF do not go to these two locations due to insecurity in the area. The acting Gendarmerie commandant of Moyenne Sido, informed us there are about 67 rebels with their local gun manufacturers who are in the bush some 30 km from Sido. They wish to have some assistance to farm and abandon their rebelled activities.

Participants & Itinerary

- Dr. Kuotong Rogers, Techn.Off. EHA/HAC Chef de Sous Bureau OMS Bossangoa - Ettie Higgins, Chef de Sous Bureau, UNICEF Bossangoa - Anicet Demaldo, Community Development Officer, UNICEF Bossangoa

Itinerary of Assessment mission

Day One: Sunday, 17th February 2008 Route: Bossangoa, east through to Batangafo (Bac is functioning)

Day Two: Monday, 18th February 2008 Route: Batangafo north to Kabo, Kabo to Moyenne Sido (return to Kabo)

Day Three: Tuesday, 19th February 2008 Route: Kabo – Batangafo – Bouca – Bangui.

Key Findings

ƒ Central African returnees from Chad have begun to spontaneously return in the past two months from UNHCR supported refugee camps in Southern Chad (Yaroungo camp). ƒ The local Croix Rouge has registered almost 14,500 returnees; however, this assessment mission estimates the total figure to be closer to 2,000 returnees. The returnees this mission interviewed do not have any registration papers and stated they were confiscated in Chad. ƒ Most the returnees are being hosted by the local population, but are now however under pressure to find alternate housing. ƒ The main source of food is foraging for wild food in the bush, collecting firewood and producing charcoal to sale and buy food. The only sources of water are some open wells and two functioning hand-pumps in Sido town. ƒ Only 50 of the returnee’s children are attending school, since the local public school is under resourced and already full, and unable to accept any more children. ƒ The health and nutritional status of both the returnees and the local population is poor, with a prevalence of malaria, diarrhoea, ARI, skin diseases and conjunctivitis. ƒ The local authorities are unable to cope with the situation in Moyenne Sido, the central government has provided no support, and there has been no cross-border liaison or communication with the Chadian authorities or camp coordinators. As a result, the mayor of the town is under a huge amount of strain to provide for the community (both host population and returnees). ƒ (In the interviews carried out, there was no indication or incidents reported of intimidation by Chadian or CAR authorities, nor were any of the returnee’s attacked while making the 4

journey from across the border into CAR). There was no case of GBV reported to the mission.

Assessment Methodology

The team consisted of 2 staff from UNICEF Bossangoa and 1 staff (Technical Officer Chef de) from WHO Sub Office Bossangoa. The assessment was conducted by a combination of interviews, focus group discussions and first hand observation. The local community leaders and the Mayor of Moyenne Sido were the entry points for discussion. Separate groups of women and men were also met in Moyenne Sido to determine their most urgent needs and assess their living conditions.

Clearing site for returnees, Moyenne Sido

Sectoral Findings

NFI’s

The team spoke to several dozen returnees, and while people have been able to bring some items with them from Chad, it was only what they could carry. No livestock or donkeys were seen in Moyenne Sido, nor were there many farming tools. The most urgent need identified therefore was for shelter. Some of the population was living out in the open under trees (only thought to be a small number of families) while the others have been staying with host families.

5

Therefore, based on the analysis of the assessment team, and based on first hand observations, the most urgent needs identified were for the following items:

1. Shelter (i.e. Plastic Sheeting) 2. Blankets 3. Mosquito nets 4. Mats 5. Jerry cans 6. Kitchen sets 7. Soap

Health & Nutrition

The health condition outside the areas of coverage of MSF-Belgium/Spain activities in the extreme east of Ouham Health District is very poor.

Moyenne Sido: The general health situation of the Sous-Prefecture prior to the arrival of the returnees was inadequate (a heath post of 5 rooms and a terrace, staffed by an auxiliary nurse and a pharmacy clerk). However, what is required in this area is a health Centre to serve the 17,000 inhabitants (projections from the 2003 census).

Returnee women and children, Moyenne Sido

6

The arrival of returnees has increased the caseload massively and put an extra strain on the already limited resources. The auxiliary nurse was ill and the mission could only interview the pharmacy clerk. The health unit is understaffed. It has not received drugs since March 2007(patients consult and go to the market or Chad to buy their drugs with the prescription, and these drugs are frequently of very poor quality). Most of the equipment is in a bad state or not sterile (on the three available scales, only the infants Salter scale with pants was functional, there is an old microscope in a box, all the surgical instruments were dirty as well as the midwife delivery kit box, and sterilising equipment was absent). Universal precaution is also insufficiently applied. The utilization rate is very low and 25-30% of patients come from Chad. Most of the patients are women. EPI activities are sporadic and mostly associated with the campaigns; the refrigerator has not been functioning for 6 months and has not yet been repaired. The Poste de Santé has only one locally made bed which serves as delivery bed. There is neither observation bed nor room.

The table below shows the frequency of most prevailing diseases diagnosed at the health post from December through February as well as some of the activities.

Diseases or December January February(1-18) activities OPD Total 49 46 11 consultations 1 Malaria 6 7 1 2 Diarrhoea 7 6 1 3 ARI 7 5 2 4 Peptic ulcer 2 5 0 disease 5 STI & PID 6 3 1 6 Dental carries 2 5 1 7 Skin diseases 2 1 1 8 Trauma and 2 2 0 wounds 9 Worms 1 1 0 10 Abortion 0 1 2 11 Puerperal 1 1 0 infections 12 Measles 1 1 0 13 Malnutrition & 1 0 1 anaemia ANC Number of 9( with 1 2 7 consultations aged 16 years) DELIVERIES Number of 7 6 0 deliveries

The only disease of epidemiologic potential the mission found in the register was measles in December 2007 and January 2008. The minimum Initial Service Package is not available and even condoms for demonstration on how to properly use it and individual kits for deliveries.

This health post is insufficiently supervised by the health district team for security reasons. Community participation is very weak and one of the team disappeared in Bangui with the money he was given in March 2007 to buy drugs with from UCM. Health services (consultations, deliveries, ANC) are free of charge and patients only had to buy their drugs.

7

Poste de Santé, Moyenne Sido

In the discussion with the returnees, their health problems were: malaria, ARI, diarrhoea, skin diseases with scabies, conjunctivitis, STI, peptic ulcer disease, asthma and rheumatism. No case of rape has been reported. The women said they were delivering at home under unhygienic conditions.

Both the returnee population and the host population stated that one of their most urgent needs is to receive health care (in addition to food and water).

Nutrition: While the mission was not sufficiently long enough to conduct a thorough assessment of the nutritional situation, but a rapid MUAC assessment reading was conducted in the village of Moyenne Sido among a mixed population of residents and returnees of children under the age of 5. Of the 15 measured, 4 were in “red” danger measures, 5 read as moderate “yellow”, and the remaining 6 were normal “green”. MSF Begium Spain(MSF-BS) made a rapid cross border assessment between the 12-13 of February 2008 which incorporated a rapid nutritional survey. They intend to share their findings by the end of the week. They left in the health post some forms, registers, excise books, a MUAC, a protocol for the management of malnutrition with Plumpy Nut and some cartons of it. One child was registered in that register.

As an interim measure, UNICEF provided 200 mosquito nets and 50 baby blankets to be given to mothers who will deliver in the Poste de Santé, and also jerry cans, mats, a box of purification powder sachets and a box of 100 Oral Re-hydration Salts (ORS) sachets were given to the Chef de Poste. Instruction was given to the pharmacy clerk on how to purify the water. A box of condoms was also given to the Health post.

8

Delivery bed, Poste de Santé, Moyenne Sido

Kabo: Here MSF-BS runs the Health Centre and 4 mobile clinic sites (Farazala, Bokayanga, N’gonkira and the IDPs Camp in Kabo). The mission had the opportunity to visit the IDP camp where MSF-BS runs a mobile clinic twice a week associated with EPI activities.

With the field coordinator of MSF-BS Kabo, it came out that this missions findings in Moyenne Sido were similar to their own findings, but for the moment they could not spontaneously extend their activities to Sido where the is a need for a NGO working in health to deliver humanitarian relief even though they are the nearest to the scene.

The mission discussed the issue of surveillance of meningitis and measles in their area. They had 7 cases of measles among whom 2 where above 18 years. We informed them they had to collect specimens of blood, urine and throat of new cases. They express some need of collection materials (tubes, peniflow, etc…)

Concerning meningitis, they had some cases in week 1(3 cases no death), week 2(2 cases no death), week 4(2 cases no death) and week 6(1 case 1 death of streptococcus B). The mission also shared observations with Solidarité in Kabo. The team leader informed the mission that for now they do not have the capacity to carry out assessment on the situation in Moyenne Sido.

For water, it will be advisable to have “forage” at the transit settlement site. The returnees, when they arrive to Kabo, will benefit form the services they are delivering to the general population. If there is any extension of activities to be done, it should be decided at the country level in Bangui.

Batangafo: In Batangafo, the mission had a joint informal working meeting with MSF-BS field staff and later with the chef the Centre de Santé Batangafo. Update of the geographic area in which they are working. MSF-BS Batangafo attempted to supervise its outreach health posts of Bongono and Croisement Moissala but due to insecurity, they stopped after two attempts due to insecurity. So it is the staff of those health posts that come to Batangafo with their weekly report of activities and return with drugs.

The mission also came to the conclusion that the bicycle UNICEF was proposing to send to Batangafo should be given to Poste de Santé croisement Moissala to ease their work and start 9 vaccination there. Community sensitization has already started. As of now the health centre has not yet started outreach vaccination activities and the Chef de centre said he sent his plan and request for this activity to the Health District at the end of the MNT campaign in January 2008.

For the sleeping sickness treatment centre, the inpatient capacity is already saturated with the passive screening and some patients are already in the waiting list. There is a plan to extend this capacity and then make strategies for active screening as the villages where the patients are from is now known. One of the main gaps in the programmes is the responsibility of the Government - that is the anti-vectorial fight with some gaps which needs to be addressed urgently. From the screening they did on sleeping sickness patients’ guardians, about 10-15% happened to be positive (stage one of the disease). They have decided to immediately treat them while they are in the hospital with the patient.

Concerning meningitis surveillance, the following data has been made available: Week’s 1 2 3 4 5 6 7 N°

Cases(C) Deaths(D)C D CDCDCD C D C D

frequency 2 1 2 0 2 1 5 3 1 0 1 1 1 1

There have been several cases of pneumoccocus (age group varying from 5 months to 53 years of whom 7 died) and a cases of H. influenza (child of 4 months who died).

Bouca: In Bouca, the mission briefly visited the hospital there to assess the health situation in the area. The staff hat the hospital stated that the population is having difficulties to settle their hospital bills for emergency surgery since the departure of COOPI at the end of January. In addition, the two Vaccine refrigerators and the freezer of the health centre are not functioning, and so the staff are now storing the vaccines now with the religious mission in Bouca. Universal precaution in the health unit was inadequate (for example: syringes are recap, and the safety boxes were overfull).

The hospital did not have a Salter scale with pants, so UNICEF has donated one to team there.

Water & Sanitation In Moyenne Sido, there are currently only two hand-pumps functioning. Other water sources used are open wells and forages. The DRH (Directeur Region Hydraulique) delivered the spare parts to rehabilitate two other hand-pumps in March 2007, one in the nearby village of Mboh and another in Moyenne Sido, but they have not returned yet to complete the work and the parts of about 6 pomps are being stored at the gendarmerie. There were plans also to install a forage in each village in the Moyenne Sido commune, but this has not yet happened.

The site that the returnees are now preparing to move to have not yet had latrine and shower sites identified. Currently, the majority of the people do not use latrines and defecate in the bush. The mission gave the community advice on where and how to build latrines and shower sites.

The Poste de Santé also does not have a latrine. However, the UNICEF team handed over a tarpaulin to the Chef de Poste so that he could organise for the construction of a latrine at the site.

Kabo: At the IDPs camp, it was noted that there is no shower block / facilities and the inhabitants are being forced to use the latrine areas as showers. This needs to be addressed, particularly for the females and children resident in the camp for protection of privacy and also for hygiene and sanitation reasons.

10

Child Protection After interviewing the mayor and the returnees, it is apparent that there are no reported cases of unaccompanied children. The only unaccompanied or orphaned children are those who lost families in the events of 2003, but who have since settled with other families in Chad.

Some of the female returnee’s interviewed did state that there were two reported cases of rape in the camp they came from in Chad. The first incident happened in early January 2008, when a 13 year old female was kidnapped and raped while out looking for food in the fields. The second incident involved the same crime, and the victim was a 12 year old female who was collecting firewood in the bush. Both received medical treatment in the camp but the perpetrator has not been apprehended.

Education Ecole sous-prefectoral de Moyenne Sido: The sous-prefecture of Moyenne Sido has only one schools, (“Ecole sous-prefectoral de Moyenne Sido”) which has two classrooms, and over 400 children, approximately 50 of whom are returnees. Many of the children are now installed in two straw huts built outside the school, with wooden logs used as benches. There is one latrine that the parents have built for the children, and a second latrine is under construction. There are four maitre-parents in the school, who have all received UNICEF-supported NRC training in 2007 in Batangafo.

There are only two blackboards in the school, and only one school book which they share. The school fees are CFA1,000 per family upon registration, paid annually, and CFA 100 per child after that time. Many families have defaulted on payments, but their children still continue to attend school.

The Directeur of the school stated urgent needs as follows: - The community is willing to construct a school canteen if WFP can provide school- feeding rations. The Mayor and Directeur stated that otherwise, if there is no provision of food, there is no incentive for the children to stay and the school will empty in April. - More text books were requested, along with furniture and blackboards and sports equipment for the school.

As an interim measure, the UNICEF team provided 20 packets of chalk, footballs, a tarpaulin to cover the outside classrooms, mats for inside the classrooms, jerry cans and water purification tablets to treat drinking water for the children, and hygiene education materials.

Ecole sous-prefectoral de Moyenne Sido

Ecole Molo: Approximately 7kms outside of the town of Moyenne Sido, Ecole Molo consists of a straw hut under the shade of trees. The school was established to cope with the extra children living in villages in

11 the surrounding quartiers. There are currently 80 girls and 70 boys attending the school, and there is 2 maitre-parents, neither of whom have received any training yet. There are no desks or materials, only two blackboards. There are no latrines at the school.

As an interim measure, the UNICEF team provided 20 packets of chalk, footballs, a tarpaulin to cover the outside classrooms, mats for inside the classrooms, jerry cans and water purification tablets to treat drinking water for the children, and hygiene education materials.

Molo bush school, Moyenne Sido

Proposed Jardin d’Enfant / Ecole Maternelle: There are no educational facilities available for children under the age of five at present, and the mayor stated that there was a great need for this age group since he estimated there are over 500 children aged between 3 and 5 in the sous-prefecture.

Recommendations

Short-term (humanitarian interventions):

1. UNHCR recommended making an assessment and registration of the returnees, in conjunction with UNHCR Chad.

2. To carry out a distribution of NFI’s to the families affected, since every household has children (to be confirmed) since the population is now extremely vulnerable. All distribution plans must take into account the special vulnerabilities of female and child- headed households, after a thorough registration and head count is conducted.

3. On the day of distribution, the UNICEF-supported team will sensitize the intended beneficiaries of the NFI’s as to their intended use. They should brief them on the use of jerry cans, soap, and proper use of mosquito nets, and basic hygiene & sanitation information. Follow-up assessment should then be completed to see how the NFI’s were put to use, and how the communities have recovered.

4. Request WFP to carry out an assessment to begin food distributions to most vulnerable sectors of the population, and explore the option of beginning school feeding programmes in Moyenne Sido.

12

5. UNICEF to explore the available options for supporting the schools in the area, and assisting DGH to expedite the construction and rehabilitation of pumps and forages. Hygiene education activities also need to be scaled up.

6. UNICEF to examine options for health and nutrition interventions in coordination with WHO.

7. UNICEF to examine ways to increase access to education for returnees, and advocate for the establishment of a jardin d’enfants in Moyenne Sido.

8. Food-for-work programmes to build/ rehabilitate schools and health centre, and small- scale gardening to restart productive activities;

9. In partnership with UNHCR, UNFPA and UNICEF WHO to negotiate with MSF-BS if they can extend their activities out there in Moyenne Sido. They should be able to deliver basic health care and referral services to Kabo as well as the Minimum Initial Service Package which each of the agency could see how they will assist MSF to achieve it. In case MSF-BS is not willing to extend out there, WHO should take its responsibility to work with the MPHPFHA and the other UN agencies in the health field to provide these services( giving subvention for the recruitment of some temporary qualified staff, providing basic health Kits including safe delivery kits, training, data collection tools).

10. The MPPHFHA and the Ouham health district should urgently send a team out to repair the refrigerator, and send a request to UNICEF and WHO for their replacement.

Medium-term interventions:

11. Assessment needed of returnees to identify those who are willing to be repatriated back to their original home in CAR (before 2003), if conditions are conducive to an organised return.

12. Allocate farming land if possible for the returnees. Starting with the 2008 planting season, provision of seeds, inputs and tools to encourage farmers and returnees to re-engage in cash crop production (such as cotton and peanuts), as well as establishment of rural credit schemes to facilitate resumption of economic activities.

13. Rehabilitate the Health Post and if possible transform it to a basic health centre where patients could be hospitalized form severe malaria, ARI, install a water point at the health centre.

------END------

13